LaserNetUS Student Ambassador Program Application

Please provide the following information to confirm your eligibility and apply for the LaserNetUS Student Ambassador Program.

Applicant Information

Title

Prof., Dr., Mr., Mrs., Mx., etc.

Pronoun

Providing this information helps ensure we use the most respectful language when addressing you.

Select

Please provide details of your pronouns

First Name*

Last Name*

Email*

Phone

Please include country code if not US, e.g. +44 (0)1234 567 8901

Affiliation*

The name of your primary home institution

Position at home Institution*

(e.g. Research Associate, Professor, etc.)

Home Institution Address*

Please contact us if this is different to your country of legal residence.

Home Institution City*

Home Institution State/Province

Home Institution ZIP/Postal Code

Home Institution Country*

Please contact us if this is different to your country of legal residence.

Select or enter value

Are you currently, or have you been in the past, a SLAC Employee, Affiliate, or User?*

Yes

Why are you interested in the student ambassador program (max. 250 words)?*

If funding were available, list the top three conferences that you would like to attend during the next year?*

Is the work that you would be presenting directly tied to an experiment at a LaserNetUS facility?*

Yes

Please list any LaserNetUS experiment numbers on which you have been a collaborator.*

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